mHealth delivered narrative intervention to increase cervical cancer screening among Malawian Women living with HIV

宫颈癌(CC)是女性艾滋病毒携带者(WLWHIV)发病和死亡的主要原因 在马拉维。筛查和治疗患有癌前病变的妇女在 预防CC，但CC筛查的可用性不会自动转化为对其的利用 在WLWHIV中。。预防WLWHIV中与HPV相关的宫颈癌，特别是在 资源有限的情况下，缺乏以预防为导向的服务，或者 以人口为导向的急性病治疗是有问题的。在文化上量身定做的证据- 需要有基础的干预措施，以增加筛查接受率。讲故事的叙事干预具有特殊的意义 承诺作为一种手段，让弱势群体(通常是低识字率)参与积极的健康行为，包括 癌症筛查。此外，通过社交媒体提供叙事干预，如讲故事 承诺让WLWHIV更积极地参与卫生预防/自我管理。 这项研究涉及以下具体目标： 第一阶段：发展阶段：制定干预措施 具体目标1：我们将开发基于真实故事的交互式多媒体干预 马拉维WLWHIV，当地社区领袖和马拉维医疗保健提供者，包括有针对性的 符合特定情况理论和期望行为的健康信息(CC筛查)。 第二阶段：实施阶段：进行试点随机临床试验(RCT) 具体目标2：我们将与三个小组(AR1：讲故事叙事+mHealth；ARM 2： MHealth；和ARM 3：注意力控制；N=180)以评估可行性、可接受性和初步 MHealth(片剂)在WLWHIV中提供的叙述性干预的有效性。我们将选出15个 在马拉维利隆圭农村地区建立艾滋病毒支助小组，并随机分配 小组采取干预策略(武器1、2或3)。在每个选定的艾滋病毒支助小组中，有12名WLWHIV 那些愿意参与这项研究的人将被前瞻性地录取。研究结果与体验式学习 这项研究将为一项更大规模的试验奠定基础，该试验可以测试干预的有效性。 虽然拟议的实施战略是循证的和有希望的，但它在艾滋病毒方面的应用是新颖的。 支持群组设置和mHealth Delivery。需要在mHealth环境中进行可行性测试 在对其在低收入国家的有效性进行更大规模的评估之前。这个项目的创新之处在于 它试图将CC筛查纳入马拉维已有的艾滋病毒支持小组系统，并 开发一种当地定制的小说叙事干预，对文化和识字敏感。建议数 这项研究意义重大，因为它有可能通过为马拉维WLWHIV配备 自信的文化和基于证据的战略，以增加CC筛查的接受率。

Cervical cancer (CC) is the leading cause of morbidity and mortality among women living with HIV (WLWHIV) in Malawi. Screening and treating women with precancerous lesions has been shown to be highly effective in the prevention of CC but the availability of CC screening does not automatically translate into their utilization among WLWHIV. . Prevention of HPV-related cervical cancers in WLWHIV, particularly in the context of resource-constrained settings where prevention-oriented services are either lacking or the health beliefs of the population are oriented toward the treatment of acute illness is problematic. Culturally tailored and evidence- based interventions to increase screening uptake is needed. Storytelling narrative interventions hold particular promise as a means to engage vulnerable (often low-literacy) populations in positive health behaviors including cancer screening. In addition, narrative interventions such as storytelling made available through social media holds the promise of engaging WLWHIV in more active participation in health prevention/self-management. This study addresses the following specific aims: Phase I: Developmental Phase: Develop intervention Specific Aim 1: We will develop an interactive, multi-media intervention based on authentic stories from Malawian WLWHIV, local community leaders, and Malawian health care providers that encompasses targeted health messages that are consistent with the situation-specific theory and the desired behavior (CC screening). Phase II: Implement Phase: Conduct a pilot randomized clinical trial (RCT) Specific Aim 2: We will conduct a pilot RCT with three groups (Arm 1: Storytelling Narrative+mHealth; Arm 2: mHealth; and Arm 3: Attention control; N=180) to assess the feasibility, acceptability, and preliminary effectiveness of a narrative intervention delivered by mHealth (tablets) among WLWHIV. We will select 15 established HIV support groups within the rural areas of the Lilongwe district of Malawi and randomly assign the group to an intervention strategy (Arms 1, 2, or 3). Within each selected HIV support group, 12 WLWHIV who are willing to participate in the study will be prospectively enrolled. The findings and experiential learning gained from this study will lay the foundation for a larger trial that can test the effectiveness of the intervention. Although the proposed implementation strategy is evidence-informed and promising, its use is novel in HIV support group settings and in mHealth delivery. There needs to be feasibility testing in the mHealth setting prior to a larger-scale evaluation of its effectiveness in a low-income country. This project is innovative in that it attempts to integrate CC screening into the HIV support group system already in place in Malawi and develops a locally tailored novel narrative intervention that is culturally and literacy sensitive. The proposed study is significant because of its potential to improve CC prevention by equipping Malawian WLWHIV with self-confidence with cultural and evidence-based strategies to increase CC screening uptakes.